Page 23 - Read Online

Li et al. Hepatoma Res. 2025;11:25 Hepatoma Research
DOI: 10.20517/2394-5079.2025.63

Review Open Access

Thermal ablation therapy for hepatocellular

carcinoma: recurrence mechanisms and intervention
strategies

1,2
1,2
2,3
1,2
Xuehan Li 1,2,# , Shun Li 2,3,# , Yingjing Li 1,2,# , Ge Yuan , Yan Zhang , Jiaqi Shi , Caiqi Liu , Xianjun Li 2,4 ,
Tongsen Zheng 1,2,3,5
1
Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang,
China.
2
Heilongjiang Province Key Laboratory of Molecular Oncology, Harbin 150081, Heilongjiang, China.
3
Department of Phase 1 Trials Center, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China.
4
Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang, China.
5
Heilongjiang Cancer Institute, Harbin 150081, Heilongjiang, China.
#
These authors contributed equally to this work.
Correspondence to: Dr. Xianjun Li, Prof. Tongsen Zheng (Lead contact), Heilongjiang Province Key Laboratory of Molecular
Oncology, Harbin 150081, Heilongjiang, China. E-mail: lixj277@mail2.sysu.edu.cn; zhengtongsen@hrbmu.edu.cn
How to cite this article: Li X, Li S, Li Y, Yuan G, Zhang Y, Shi J, Liu C, Li X, Zheng T. Thermal ablation therapy for hepatocellular
carcinoma: recurrence mechanisms and intervention strategies. Hepatoma Res. 2025;11:25. https://dx.doi.org/10.20517/2394-
5079.2025.63
Received: 7 Sep 2025 First Decision: 10 Nov 2025 Revised: 14 Nov 2025 Accepted: 28 Nov 2025 Published: 10 Dec 2025

Academic Editor: Binyan Zhong Copy Editor: Ting-Ting Hu Production Editor: Ting-Ting Hu

Abstract
Thermal ablation, including radiofrequency ablation and microwave ablation, is a critical treatment modality for
early-stage hepatocellular carcinoma (HCC); however, the high postoperative recurrence rate remains a significant
challenge. Underlying mechanisms of post-ablation recurrence - including autophagy, epithelial-mesenchymal
transition, hypoxic microenvironment formation, and immune suppression - are being progressively elucidated.
Insufficient ablation is considered a key initiating factor for these processes. Advanced imaging techniques have
thus been developed to improve intraprocedural monitoring and margin assessment, aiming to prevent insufficient
ablation. For cases with confirmed residual or recurrent tumors, integrated therapies such as transarterial
chemoembolization, radiotherapy, immunotherapy, and nanomedicine offer promising salvage options to mitigate
further recurrence and improve survival. This review summarizes the mechanisms of tumor recurrence following
HCC ablation and discusses potential countermeasures, aiming to provide valuable insights for clinical practice.
Keywords: Thermal ablation, hepatocellular carcinoma, tumor recurrence, combination therapy

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/hr